McCullough Pharmacy Inc
Organization Active NPI Community/Retail Pharmacy · Walworth, WI
NPI 1881703676 · NPPES record last updated Sep 13, 2007
Key facts
- NPI
- 1881703676
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 5931042 (WI)
- Legal business name
- MCCULLOUGH PHARMACY INC
- Practice address
- 547 Kenosha St
Walworth, WI 53184-9512 - Phone
- (262) 275-2137
- Fax
- (262) 275-5743
- NPI assigned
- Aug 29, 2006
- Organization subpart
- No
Authorized official
- Name
- James McCullough
- Title
- President
- Phone
- (262) 248-8582
National Provider Directory
Locations
547 Kenosha St
Walworth, WI 53184
Phone (262) 275-2137
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 5931042 | WI | Yes |
Addresses
Primary practice location
547 Kenosha St
Walworth, WI 53184-9512
Mailing address
547 Kenosha St
Walworth, WI 53184-9512
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 33086500 | Medicaid | WI | |
| 5110022 | Other | OTHER ID NUMBER |
Other names
- MCCULLOUGHS PRESCRIPTION AND GIFTS
Other providers in Walworth, WI
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- Michael C. Nice
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All providers in Walworth, WI · Community/Retail Pharmacy in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 13, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.